Need help with ACA for my daughter

[HokieHill]

Hi - long time lurker and I have an ACA question for my daughter. Not a retirement question necessarily but there are many people here experienced with ACA and I hope someone can give assistance and/or point me to a resource that can help.

My daughter is 25, her birthday is 9/11/99. She started a Physical Therapist job 10 months ago. She is still on my health insurance from megacorp but also signed up for health insurance at her work this year. She has double insurance until 9/11/25, then just her insurance. She had a severe hip injury when she was 9 yrs old, required surgery and we knew she would need hip resurfacing when she was young. Hip resurfacing is similar to hip replacement but requires a highly skilled surgeon to be successful. She needs a hip resurfacing now and is scheduled for surgery 5/7/25. We cannot delay the surgery and she will need 6 months to recover before returning to work. There is a small risk of complications after 6 months and if one arises it can be costly and may require her to see a specialist or move to a hip replacement.

She does not qualify for FMLA because she hasn't worked at her company for a year. I'm concerned the company will let her go. She will come off my insurance on 9/11/25 which will be 5 months after surgery.

My questions are these - will she be able to get health insurance through ACA and will the insurance cover any complications that may arise after 9/11/25 from the surgery that was completed 5/7/25? Should I get legal counsel on this, and if so any recommendation for lawyers that deal with this kind of issue?

I'll stop there - ask me questions.

 

[aaronc879]

If they let her go, she should still have insurance thru the end of the month. By the start of the next month you should be able to have ACA if she calls right away after she is let go to sign up for an ACA plan. Pre-existing conditions do not apply so she should be covered for whatever she needs with her paying some based on the plan she selected. No need for any legal counsel as far as I can see.

 

[PaunchyPirate]

She will automatically become eligible for ACA insurance when her current insurance ends. She can start the application process for the ACA policy up to 60 days prior. Insurance companies cannot take existing conditions into consideration. In fact, there are no questions asked about your health during the enrollment process except whether you are a smoker or not.

She should be covered as of the first day of the ACA policy start. She WILL restart her annual deductible. So you may want to consider a plan that has a lower one if you expect expenses this year. Of course, that is always a numbers game since lower deductible policies have higher premiums.

In theory, this should not be a major concern for you.

 

[PaunchyPirate]

If they let her go, she should still have insurance thru the end of the month.

While this is common, it is by no means a certainty. My coverage ended the day I left employment. Not the end of the month. Everyone needs to inquire about this from their employer.

 

[HokieHill]

That's what I thought but want to be sure. Thanks for the quick response.

 

[PaunchyPirate]

I believe she would also qualify for COBRA from her employer, wouldn’t she? But I don’t know if that happens when she was also on the parent’s plan. COBRA could be expensive, but it would maintain current coverage continuity. At least of the employer plan.

 

[aaronc879]

I believe she would also qualify for COBRA from her employer, wouldn’t she? But I don’t know if that happens when she was also on the parent’s plan. COBRA could be expensive, but it would maintain current coverage continuity. At least of the employer plan.

If she is only working 4 months this year then she will likely be able to get an ACA plan for FAR less than what Cobra would cost per month plus get cost sharing which would make her deductible and max out of pocket fairly low. ACA seems like the obvious choice. She can not sign up for ACA if she has any other insurance coverage though so she would have to wait until she is off her parents plan when she turns 26.

 

[PaunchyPirate]

If she is only working 4 months this year then she will likely be able to get an ACA plan for FAR less than what Cobra would cost per month plus get cost sharing which would make her deductible and max out of pocket fairly low. ACA seems like the obvious choice. She can not sign up for ACA if she has any other insurance coverage though so she would have to wait until she is off her parents plan when she turns 26.

Indeed. I wasn’t advocating COBRA. Simply laying out options. And sometimes, it’s not all about money. If the comfort of continuing with what they have and are familiar with in a complicated situation is appealing, it’s an option.

 

[Dalton]

True. A number of years ago, I left a state job with a GREAT health insurance policy, to go to a private business that didn't offer insurance at the time (but was going to start within a year due to ACA requirements), so my choice was to continue my GREAT insurance policy using Cobra, or get an ACA plan (full price due to my income), so I went with the Cobra option for a little more money. The peace of mind was huge, but I also had to factor in that I'd been having some heart issues in the previous 1-2 years, so it wouldn't take much to make it worth the extra $.

 

[RetiredAndLovingIt]

She also needs to make sure her ACA plan covers the doctors, specialists and hospitals that she wants to continue using.

 

[athena53]

While this is common, it is by no means a certainty. My coverage ended the day I left employment. Not the end of the month. Everyone needs to inquire about this from their employer.

Same here. I quit because of toxic politics and told the boss I was willing to leave if they'd "keep me on the payroll" through the end of the month. Boss and I interpreted that far differently. Lump sum payment through the end of the month, no 401(k) deductions taken out, no health insurance. I was doing a sprint triathlon that weekend. COBRA had been farmed out to some company that didn't provide a way to sign up but they told me it could be retroactive once I got the info, which I believed to be true, but wouldn't help if I got taken off the course with an injury that required an ambulance ride. Fortunately I had no health issues before officially signing up and paying premiums.

Definitely worth checking out.

 

[Irishgirlyc58]

Another thing to consider is if you are in a Medicaid expansion state and your daughter is income eligible she may get put into Medicaid when applying for ACA. I think that there is a way to keep that from happening but I would find out the particulars before she’s in the middle of her medical procedure.
I would want to know all of the options available for her health insurance and any pitfalls before the healthcare switch happens.

Good luck. I’m sure that you are all anxious about the procedure along with her health care coverage.

 

[orchid55]

I would just add that you may want to check out what types of ACA plans are available in your area. In my state all of the ACA plans are HMOs, with many of them being very narrow network plans. If she already has certain specialists and hospitals she needs to use, it might be a good idea to see if any of the local ACA plans cover the specialists and or hospitals. COBRA is expensive but if it covers her current doctors it might be the best option medically.

 

[wrigley]

I'm sorry but I have to ask. Why not just have hip replacement surgery which a 25 year old will fully recover from in 1 to 2 weeks? My 89 year old MIL had her hip replaced and she was back to walking normal in 10 days pain free. I wish your daughter well.

 

[Aerides]

Cobra is expensive but worth it for a short period when continuity of care is important. I'd seriously be open to covering my kid for a few months of premiums just to take away that stress, which is also not something helpful to her healing after surgery.

Have her get a quote for Cobra from her HR, and tell her "I got this" thru the end of the year?

She can ship for an aca plan that starts on Jan 1.